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	Name e-mail Tel No. FAX No. if available Requested date of moving Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 am pm Present address Room type 1R 1K 1DK 2DK 2LDK 3DK 3LDK or more Floor 1F 2F 3F 4F 5F or more elevator available not available New address Room type 1R 1K 1DK 2DK 2LDK 3DK 3LDK or more Floor 1F 2F 3F 4F 5F or more elevator available not available Please check or select the following check-box for goods to be moved refrigerator (big) refrigerator (small) microwave oven washing machine bed (single) bed (double) FUTON carpet couch cupboard bookshelf (big) bookshelf (middle) bookshelf (small) table desk video player chair no chair 1 2 3 4 5 or more TV no TV 14 inch or smaller 21 inch 25 inch 27 inch 29 inch or bigger computer (desktop type) computer (note type) air-conditioner electric fan bicycle carton box 1-10 11-20 21 or more any other request